Treatment of Asthma

In this article

The goals of asthma therapy are to prevent your child from having chronic and troublesome symptoms, to maintain your child's lung function as close to normal as possible, to allow your child to maintain normal physical activity levels (including exercise), to prevent recurrent asthma attacks and to reduce the need for emergency department visits or hospitalizations, and to provide medicines to your child that give the best results with the fewest side effects.

Medicines that are available fall into two general categories. One category includes medications that are meant to control asthma in the long term and are used daily to prevent asthma attacks (controller medications). These can include inhaled corticosteroids, inhaled cromolyn or nedocromil, long-acting bronchodilators, theophylline, and leukotriene antagonists. The other category is medications that provide instant relief from symptoms (rescue medications). These include short-acting bronchodilators like albuterol. Systemic corticosteroids, like prednisone or methylprednisolone (Medrol), are used for severe persistent symptoms for a short course of treatment but these medications can take hours, or even days, to become effective. Inhaled ipratropium may be used in addition to inhaled albuterol following asthma attacks or when asthma worsens. It's important to understand the difference between controller and rescue medications and to use them appropriately.

In general, doctors start with a high level of therapy following an asthma attack and then decrease treatment to the lowest possible level that still prevents asthma attacks and allows your child to have a normal life. Every child needs to follow a customized asthma management plan to control asthma symptoms. The severity of a child's asthma can both worsen and improve over time, so the type (category) of your child's asthma can change, which means different treatment can be required over time. Treatment should be reviewed every 1-6 months, and the choices for long- and short-term therapy are based on how severe the asthma is.

Talk to your doctor about the various medications available to treat asthma.

Severity of Asthma

Long-Term Control

Quick Relief

Mild intermittent asthma

Usually none

Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler more than 2 times per week, long-term control therapy may be necessary.

Mild persistent asthma

Daily use of low-dose inhaled corticosteroids or nonsteroidal agents such as cromolyn and nedocromil (anti-inflammatory treatment), leukotriene antagonists (such as montelukast)

Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler everyday or starts using it more and more frequently, additional long-term therapy may be needed.

Moderate persistent asthma

Daily use of medium-dose inhaled corticosteroids (anti-inflammatory treatment) or low- or medium-dose inhaled corticosteroids combined with a long-acting bronchodilator or leukotriene antagonist

Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler everyday or starts using it with increasing frequency, additional long-term therapy may be needed.

Severe persistent asthma

Daily use of high-dose inhaled corticosteroids (anti-inflammatory treatment), long-acting bronchodilator, leukotriene antagonist, theophylline, omalizumab (for patients 12 years old and older with moderate-to-severe asthma brought on by seasonal allergens despite inhaled corticosteroids, especially if they are dependent on systemic steroids)

Inhaled beta-2 agonist (short-acting bronchodilator)

If your child uses the short-acting inhaler everyday or starts using it with increasing frequency, additional long-term therapy may be needed.

Acute severe asthmatic episode (status asthmaticus)

This is severe asthma that often requires admission to the emergency department or hospital.